A Messy Grieving Process Is Still a Healthy OneNew research challenges assumptions about the well-known stages of grief. It was commonly thought that mourners experience each stage one by one, but a research team has found that the process is actually more complex.

They are the well-known stages of grief: denial, anger, depression and acceptance. And it's commonly assumed that we move through those stages one by one as we mourn the death of a loved one. But therapists and other experts in bereavement have long suspected it's not quite that simple. Some new research tries to spell out just what is the normal process of grief.

NPR's Joseph Shapiro reports.

JOSEPH SHAPIRO: As researchers, Holly Prigerson and Paul Maciejewski study grief. They're married, so they spent a lot of time talking about their work even when they're at home.

SHAPIRO: She teaches at Harvard Medical School. He teaches at Yale. For their latest research, Prigerson and Maciejewski wanted to test what doctors in medical school get taught - that when people mourn, they go through a series of stages. Prigerson, who also works at the Dana-Farber Cancer Institute, says it's something that's been accepted but not closely studied.

Prof. PRIGERSON: Some people say, you mean, that hasn't been tested yet? And it even struck us as odd that it's just been out there so long.

SHAPIRO: So they led a team that for two years followed 233 people who were mourning the death of a loved one. Most had lost a spouse. For some, it was a parent, a child or a sibling. The deaths were by natural causes, and often expected deaths - someone dying from cancer or a long illness.

Their research confirmed parts of the stage theory of grief. But it also found big differences. For one thing, acceptance was the most common feeling, and it often came early in the grieving process. That runs counter to what's been commonly thought. And the main negative feeling wasn't sadness or anger.

Professor PAUL MACIEJEWSKI (Yale University): Yeah. I think, commonly, people think that people are sad, following a loss - sadness or depression. But really, yearning is more the dominant characteristic feature.

Prof. PRIGERSON: It was all about yearning. Grief is really about yearning and not sadness.

SHAPIRO: It's that sense of really missing or pining for the person who died.

Prof. PRIGERSON: That sense of heartache - it's been called pangs of grief. And it's normal even two years after the death of someone or five years to every once in a while get one of those pangs of grief. Oh, something reminds you of your father who died, and suddenly it's a bittersweet - oh, I remember when he was there. It could be a happy moment, but it's also sad because you miss them.

SHAPIRO: The idea that different people grieve in different ways is no surprise to many who counseled the bereaved, like Marcia Lattanzi-Licht. She's a nurse, a psychotherapist and she's written about grief. She welcomes research that goes beyond the stage theory.

Ms. MARCIA LATTANZI-LICHT (Psychotherapist, Nurse): I think when we consider stages, then we place expectations upon people that there's a certain way they should behave or be. And that probably is never a really good idea.

SHAPIRO: Lattanzi-Licht says people go through all the stages, or just some of them. Often, people will be in more than one stage at the same time. They can be accepting and yearning, for example. She says the new research will be reassuring.

Ms. LATTANZI-LICHT: And what it does is normalize some parts of the experience. People long to know that they're sort of on track, because grief can be a crazy maker. It really throws you off the map that you live your life on.

SHAPIRO: The new research appears in the Journal of the American Medical Association.

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